The epidemic of childhood obesity and resulting health and economic consequences are now widely recognized. Low income and minority children are at highest risk and contribute most to the economic burden. Primary care providers and practices are in a key position to identify children at risk for or already overweight and to intervene. While providers are viewed as influential leaders, they generally lack the tools, training, reimbursement, time, and support needed to successfully mount either practice-based or community-level interventions and consequently lack confidence that they'can combat this growing epidemic. We propose a three phase project in an existing primarily rural practice network serving Medicaid families: Phase I: Refine culturally appropriate, evidence-based, arid theory-driven intervention materials and strategies to guide clinic-based interventions. We have developed and are pretesting a Provider Toolkit and Local Care Manager (LC Manager) intervention and will have pilot data results in July '05 regarding feasibility and short term impact on physician and family behavior. The Provider Toolkit includes streamlined assessment and counseling tools to facilitate rapid BMI and lifestyle behavior risk communication and guide 2-3 minute counseling sessions. The LC Manager intervention uses disease management principles of coaching, education, advocacy, and community resource linkages, supported by an innovative family-based program: "Families Eating Smart and Moving More." Phase I will include formative work to culturally adapt all interventions for Hispanic families. Phase II: Conduct a randomized controlled trial to determine the effectiveness and cost effectiveness of the Provider Toolkit and LC Manager interventions on 4-11 year old Medicaid children (20 children in each of 24 practices), and assess intervention impact on providers. We will use a 2x2 experimental design to assess the independent and combined effects of these interventions on percent body fat relative to usual care, and examine secondary outcomes including BMI, diet, physical activity, microalbuminuria, and psychosocial measures. Phase III: Determine whether primary care providers, after implementing a practice-based, pediatric obesity intervention in the clinical setting (Phase II) can subsequently initiate environmental/policy change in their local communities. We will determine the proportion of providers who, when linked with local community leaders, state and local public health resources, models for change, and ongoing technical assistance, will report meaningful action steps toward community-based environmental and policy change supporting healthy eating and increased physical activity as measured by the ProgressSChecktracking system.